\section{Insurer Risk and Maximum Sustainable Benefits}
\label{sec:InsurerRiskandMaximumSustainableBenefits}

I can compare insurers' Maximum Sustainable Benefits ($MSB_N$) when matching $PI$'s probabilities of: Profits of at least 5\%; or Avoiding operating losses. Each constraint produces different $MSB_N$s. Until now, insurers paid identical benefits, to efficient providers, for identical symptoms. But Table~\ref{tab:InsurerOperatingResultsByPortfolioSize} Rows 4 and 5, revealed that larger and smaller insurers have different probabilities of earning profits, or avoiding operating losses, than $PI$, so they cannot offer identical benefits \emph{and} match $PI$'s profitability or loss avoidance performance.

\subsection{Maximum Sustainable Benefits for Profits of 5 Percent}
\label{sec:MaximumSustainableBenefitsforProfitsof5percent}

Insurers' Maximum Sustainable Benefit For Profits of 5\%\index{Maximum Sustainable Benefit For Profits of 5\%} ($MSBP5_N$)\index{$MSBP5_N$} are the highest portion of a premium dollar insurers can pay, throughout the year, and match $PI$'s probability (0.8413) of profits of at least 5\%. To adjust for differences in PLRE variability, $MSBP5_N$ = 0.8000 - 1 * $\sigma_{e_{N}}$ because PLREs above 0.8000 do not yield these profits. Table~\ref{tab:InsurerOperatingResultsByPortfolioSize} Row 11, shows $MSBP5_{NHI}$ = 0.79715 and $MSBP5_{B}$ = 0.78419. $NHI$ and $B$ can pay higher benefits than $PI$ (0.7500), but $MSBP5_{D}$ = 0.6419 and $MSBP5_{E}$ = 0.3000. $E$ must cut $PI$'s benefits by 60\% because it is so inefficient. 

Table~\ref{tab:InsurerOperatingResultsByPortfolioSize} Row 12 shows dollar values of average policyholder benefits ($MSBP5_N$ * \$4,000). $NHI$, $B$, $PI$, $D$ and $E$ can provide average benefits of: \$3,189;  \$3,137; \$3,000; \$2,568; and \$1,200. Contrary to capitation advocates' claims, these are reduced benefits, cuts in medically necessary and appropriate care due to providers' inefficient insurance operations, not capitation induced savings from increased clinical efficiency.

%The importance of these reduced benefits cannot be overstated. During the course of the last four decades, since managed care and capitation became dominant health care finance mechanisms, the amount of time health care providers devote to patient assessment and treatment has declined dramatically. Office visits that were once 15 - 30 minutes long are now completed in 2 - 3 minutes, or less. This results in missed symptoms, missed diagnoses, inadequate, ineffective, or no treatment for patient conditions that would be detected and treated in a less rushed environment.

%Surgeons, who used to perform small numbers of operations per day, now schedule dozens of patients in a few hours. Overbooked surgeons and operating staff and facilities have more and more difficulty accommodating these new demands for ``efficiency.'' Surgeons operate on the wrong patients or the wrong sites with increasing frequency. Operating rooms are recycled for use without proper cleaning and sterilization, leading to increased numbers of hospital acquired infections. Rushed operating rooms cause errors which compromise the care for dozens of other patients and interfere with the activities of nurses, operating room personnel, and other surgeons. Even minor delays affect staffing, surgical supplies, sanitation, and the quality of care for everyone.